Provider Demographics
NPI:1467272997
Name:BURRIS, GRACE HAIGH (EDS)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:HAIGH
Last Name:BURRIS
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:DUBOIS
Other - Last Name:HAIGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS
Mailing Address - Street 1:3737 SHAFER CIR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-4728
Mailing Address - Country:US
Mailing Address - Phone:317-796-7540
Mailing Address - Fax:
Practice Address - Street 1:3025 WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-8905
Practice Address - Country:US
Practice Address - Phone:317-773-2915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10319719103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool